Optimal Use of Targeted Therapy and Immunotherapy in Early-Stage, Resectable Non-Small Cell Lung Cancer.
Raymond U Osarogiagbon, Jeremy P Cetnar, Raid Aljumaily
https://pubmed.ncbi.nlm.nih.gov/42335416/Actively Recruiting
Led by National Cancer Institute (NCI) · Updated on 2026-08-11
306
Participants Needed
273
Research Sites
N/A
Total Duration
Researchers are evaluating durvalumab, an immunotherapy drug, compared to standard patient observation after surgery in patients with early-stage non-small cell lung cancer who have no remaining cancer cells. This phase III trial aims to determine if durvalumab can improve outcomes such as disease-free survival and overall survival compared to the usual approach of monitoring without additional treatment. The study also assesses quality of life, side effects, and patient-reported symptoms. Participants are randomly assigned to one of two groups. One group receives durvalumab intravenously once every 28 days for up to 12 cycles unless the disease progresses or side effects become unacceptable. The other group undergoes active surveillance with regular monitoring. Both groups have computed tomography scans and blood samples collected throughout the 12-month study period. After treatment or observation, patients are followed annually for up to 10 years. Participants will complete questionnaires about their quality of life and symptoms. Researchers will monitor disease recurrence, new lung cancers, and overall survival for up to 10 years. Blood tests and imaging scans will be used to track health status and side effects. Safety and adverse events are evaluated during and after treatment, with long-term follow-up to assess the durability of outcomes.
CONDITIONS
Immunotherapy After Surgery for People Who Have No Remaining Cancer Cells After Standard Treatment for Early-Stage Non-Small Cell Lung Cancer, INSIGHT Trial
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National Cancer Institute (NCI)
Lead Sponsor
This table compares participation in this trial with other options available for this condition. The information is drawn from published research and the trial’s study details and is provided for educational purposes only.
| Factors | Durvalumab Immunotherapy After Surgery | Active Surveillance (Standard Post-Surgical Monitoring) |
|---|---|---|
| What it is | Durvalumab is an intravenous immunotherapy drug (an anti-PD-L1 antibody) given after surgery and neoadjuvant chemo-immunotherapy to patients with early-stage NSCLC who have achieved complete pathological response. It is given as adjuvant (post-surgical) therapy. | Active surveillance involves close clinical and imaging follow-up after surgery and neoadjuvant chemo-immunotherapy, without additional adjuvant systemic therapy. This means no further immunotherapy or chemotherapy is administered unless there is disease recurrence. |
| Role in the trial | Used as the investigational immunotherapy to test whether continued PD-L1 blockade after surgery improves disease-free survival in this setting. | Functions as the control group, representing the standard-care approach of monitoring after surgery and neoadjuvant treatment in this highly selected population. |
| Primary use | Intended to reduce the risk of cancer recurrence or death after curative surgery and neoadjuvant combination treatment, by sustaining immune checkpoint blockade in patients with a pathologic complete response. | Provides close follow-up to detect recurrence early but involves no further cancer-directed drug therapy after surgery and initial standard therapies have resulted in complete pathological response. |
| How it is given or performed | Given by intravenous infusion according to the trial protocol, following surgery and standard neoadjuvant therapy. The specific dosing schedule follows standard durvalumab adjuvant regimens. | Consists of regularly scheduled follow-up visits, imaging (such as CT scans), and laboratory tests to monitor for disease recurrence. No additional medication is administered unless recurrence is detected. |
| Evidence status | The use of durvalumab after surgery and neoadjuvant chemo-immunotherapy in patients with pathologic complete response is under active investigation. Published literature supports immunotherapy in early-stage NSCLC, but trial results for this population are not yet available. | Active surveillance after complete (R0) resection and neoadjuvant treatment remains a widely accepted standard, though recurrence risk persists. External reviews indicate existing evidence and guideline support for this approach in the post-treatment, pathologic complete response, early-stage NSCLC setting. |
| Important limitations | Benefit for durvalumab in this precisely defined post-surgical, post-neoadjuvant, pathologic complete response population has not yet been established. Potential immune-related adverse effects are possible, as with other checkpoint inhibitors. | Ongoing risk of disease recurrence remains after surgery and neoadjuvant therapy, even with a pathologic complete response. Surveillance alone does not actively reduce recurrence risk. |
Disclaimer: This comparison is created with the help of artificial intelligence(AI) and may contain errors or missing information. It is not medical advice and does not mean one option is better or safer than another. Clinical trials are still being studied, and joining a trial is your choice. Please consult your healthcare professional before making any decisions.
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Duration - Up to 12 weeks before randomization
Participants are screened for eligibility to participate in the trial.
Initial surgery and medical evaluation
Duration - 12 months
Participants are randomly assigned to receive durvalumab infusions every 28 days for up to 12 cycles or to undergo active surveillance with regular scans and blood tests for 12 months.
Monthly visits for durvalumab infusions or regular monitoring visits for surveillance group
Duration - Up to 10 years
After treatment or surveillance, participants are followed annually for up to 10 years to monitor health and detect any cancer recurrence.
Annual follow-up visits
Study Type
INTERVENTIONAL
Masking
NONE
Allocation
RANDOMIZED
Model
PARALLEL
Primary Purpose
TREATMENT
Number of Arms
2
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Raymond U Osarogiagbon, Jeremy P Cetnar, Raid Aljumaily
https://pubmed.ncbi.nlm.nih.gov/42335416/National Cancer Institute (NCI)
Lead Sponsor